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Present and future of HTA Ideas, methods, and goals
Joan MV Pons TM
AQuAS
11ª reunión AEETS
Barcelona, 13-14 Noviembre 2014
Parallel pathways
Health Technology
Assessment (HTA)
80’s (20th Century)
Focus on social effects
Policy and decision
makers
High cost technology
Cost containment
Economic analysis (CEA,
CUA, CBA)
Evidence-based medicine
(EBM)
90’s (20th Century)
Focus on efficacy and
safety
Clinicians and academy
Clinical epidemiology
Inappropriateness
Levels of evidence and
recommendations
2
Evidence-based policy
At the turn of the Century
3
Information and communication technology
Digital revolution omnipresent
Molecular biology explosion (wider gap)
Knowledge overload
Change in medical-patient relationship
Informed citizens: sovereign consumer
Expansion of healthcare budgets
Costly medical technology (costly research)
At the turn of the Century
4
Cochrane and Campbell collaboration
Clinical practice guidelines (CPG)
Up-to-date
Clinical trials registers
European HTA Collaboration
Spanish Network of HTA agencies
Multiple stakeholders, multiple interests
Manufacturers
Pharmaceuticals
Medical devices
Biotech
ICT
Healthcare providers
Hospitals
Primary care
Integrate organizations
Others (lab, image,..)
Insurers
Public
Private
Individuals
Sick or healthy
Patients’ organizations
Social networks
Healthcare professionals
Scientific societies
Professional associations
Universities and Schools
Regulatory agencies
Biomedical researchers
Funding agencies
Charities and philanthropy
and many other
CRO, advertising agencies,
Journals and general media
Business schools
Policy-
makers
Public
health
AQuAS perspective
Healthcare professionals
Reduce uncertainty (CPG, PHT)
Reduce waste (Essencial)
Outcomes feedback (CdR)
Citizens - patients
Shared decision making
Providers outcomes
Process participation
Patients’ Council
(reliable) INFORMATION (sound) KNOWLEDGE
AQuAS perspective
Healthcare organizations
Quality indicators
ICT applications
Integrative models
Public health insurer
Reimbursement decisions
Planning of services
Independent advice
(reliable) INFORMATION (sound) KNOWLEDGE
8
AQuAS perspective
Biomedical research community
VISC+ project
CdR on research in health sciences
Marató TV3 (Catalan telethon)
Assessment of research institutions,
groups, individuals, and projects
TRANSLATIONAL MEDICINE
AQuAS perspective
9
Drug and medical devices manufacturers
Difficult relationship
Early dialogue
Coverage with evidence
Conflict of interest policy
VISC+
Scientific and social value judgment
Individual
Groups
Organizations
Society
Utilitarianism QALY Social threshold
Needs of present and future anonymous patients
Accountability for reasonableness
Human rights
Autonomy
Non-maleficence
Beneficence
Distributive
justice
Healthcare
System as
a social
institution
rescue rule
Analytical tools: quantitative approach
11
Knowledge is “out there” to be discovered: a physical and
knowable reality that can be observed/analyzed
Measures: data (nominal, ordinal, interval, ratio). Validity,
reliability of good measures
Correlation research
Observational and experimental studies
Deductive methods (theory/hypothesis→empirical observation→conclusion)
More predictive than descriptive
Vanderstoep SW, Johnston DD. Research methods for everyday life. Blending qualitative and quantitative
approaches. Jossey-Bass. San Francisco, CA, 2009
Example of analytical tools
Quantitative approach
Analytical tools: qualitative approach
13
Knowledge is within the perceptions and interpretation
of the individuals (social construction of reality)
Social and cultural construction of meaning
Interviews / focus groups /observation
Ethnography (culture), phenomenology (experience),
textual analysis (language/symbols)
Inductive methods (observation → theory/hypothesis → interpretation)
More descriptive than predictive
Vanderstoep SW, et al. Research methods for everyday life. Blending qualitative and quantitative approaches.
Jossey-Bass. San Francisco, CA, 2009
Examples of analytical tools
14
Qualitative approach
Thank you very much
http://aquas.gencat.cat/ca/